Año 2022 / Volumen 114 / Número 7
Original
Documento de consenso de la Sociedad Española de Patología Digestiva y de la Sociedad Española de Trombosis y Hemostasia sobre hemorragia digestiva masiva no varicosa y anticoagulantes orales de acción directa

375-389

DOI: 10.17235/reed.2022.8920/2022

Fernando Carballo, Agustín Albillos, Pilar Llamas, Aitor Orive, Eduardo Redondo-Cerezo, Enrique Rodríguez de Santiago, Javier Crespo,

Resumen
Introducción: existe limitada experiencia y conocimiento sobre la hemorragia digestiva masiva no varicosa durante el tratamiento con anticoagulantes orales de acción directa. Objetivos: aportar definiciones y recomendaciones basadas en la evidencia. Métodos: documento de consenso elaborado por la Sociedad Española de Patología Digestiva mediante metodología Delphi modificada. Se constituyó un panel con 24 gastroenterólogos con experiencia en hemorragia digestiva y se evaluó la mejoría del acuerdo a lo largo de tres rondas. Las recomendaciones finales se fundamentan en una revisión sistemática de la literatura y la utilización del sistema GRADE. Resultados: los panelistas estuvieron de acuerdo en el 91.53 % para el conjunto de los 30 ítems, porcentaje que mejoró en las rondas 2 y 3 en aquellos ítems en los que existe menor experiencia clínica. El desacuerdo explícito fue solo del 1.25 %. Se ha podido establecer una definición de hemorragia digestiva masiva no varicosa en los pacientes tratados con anticoagulantes orales de acción directa y generar recomendaciones para optimizar el manejo de esta patología. Conclusión: la aproximación a este tipo de pacientes críticos debe ser multidisciplinar y protocolizada, optimizando las decisiones dirigidas a la identificación precoz del problema y a la estabilización del paciente bajo el principio de la reanimación con control de daños. Por ello, se debe valorar la reversión inmediata del efecto anticoagulante, preferentemente con los correspondientes antídotos (idarucizumab para dabigatrán y andexanet alfa para los inhibidores directos del factor Xa), la reanimación hemostática y la identificación y tratamiento del punto de sangrado.
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Carballo F, Albillos A, Llamas P, Orive A, Redondo-Cerezo E, Rodríguez de Santiago E, et all. Documento de consenso de la Sociedad Española de Patología Digestiva y de la Sociedad Española de Trombosis y Hemostasia sobre hemorragia digestiva masiva no varicosa y anticoagulantes orales de acción directa. 8920/2022


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